Association between fluoroquinolones and Achilles tendon injuries: A systematic review

Abstract

Objective: To analyze the available scientific evidence on the association between fluoroquinolone use and the risk of Achilles tendon injuries, including tendinopathy, tendinitis, and tendon rupture, compared with unexposed individuals or those exposed to other antibiotics. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) recommendations. Searches were performed in MEDLINE via PubMed, Embase, the Cochrane Library, SciELO, and Google Scholar as a supplementary search source. Study selection, data extraction, and methodological quality assessment were performed by two independent reviewers using Joanna Briggs Institute tools according to each study design. Results: Seventeen studies were included, predominantly cohort studies, case-control studies, and case reports, with higher methodological quality among studies with a comparator group. The evidence indicated an association between fluoroquinolones and an increased risk of tendinitis, tendinopathy, and Achilles tendon rupture, particularly during the first weeks after exposure. Risk was higher among older adults, patients with renal impairment, diabetes mellitus, obesity, and corticosteroid users. Ciprofloxacin and levofloxacin were the drugs most frequently associated with tendon outcomes. Conclusion: Fluoroquinolones are associated with an increased risk of Achilles tendon injuries, particularly among individuals with predisposing factors. Early identification of at-risk groups and judicious prescribing of these antimicrobials may reduce severe tendon complications. Level of evidence V; Systematic Review